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Does Medicare cover annual physical exams?

Though Medicare doesn’t pay for the type of comprehensive exam that most people think of as a “physical,” it does cover a one-time Welcome to Medicare checkup during your first year after enrolling in Part B. After that, it covers annual wellness visits scheduled to keep track of your health.

Medicare defines a routine physical exam as one that’s performed without a relationship to treatment or diagnosis of a specific illness, symptom, complaint or injury.

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Federal law specifically prohibits Medicare from covering routine physical exams. However, Medicare coverage has expanded to pay for the following checkups and preventive care in specific circumstances:

  • Medicare covers an annual wellness visit every 12 months after your first year with Medicare Part B. This annual visit was added to Medicare Part B coverage by the Affordable Care Act and became available without deductibles or copayments starting in 2011.  
  • Coverage for several preventive services without any out-of-pocket costs also was added through the Affordable Care Act, including many screenings and vaccines. You may need to meet age or risk requirements for some of these services to be covered.  

How is a physical different from Medicare’s wellness exam?  

In an annual physical, a doctor examines you, may do bloodwork and other tests and looks for problems even though you don’t have a specific complaint or risk.

The Welcome to Medicare checkup and annual wellness visit focus more on preventive care. Your doctor can review your risk factors, develop a personalized health plan for you, check that you’re up to date with preventive tests such as cancer screenings and flu shots and may refer you for other tests. The items included in the two types of visits are slightly different. 

The Welcome to Medicare checkup is an introduction to Medicare and its covered benefits and focuses on health promotion, disease prevention and detection to help you stay well. It’s an opportunity for your doctor to assess your health and provide a plan for care. Your doctor may do the following during this visit:

  • Ask about your personal and family health history.
  • Assess your potential for depression.
  • Check risk factors that could indicate serious illnesses.
  • Determine your ability to function independently and your level of safety, such as how well you perform activities of daily living and your risk of falls.
  • Offer to talk about advance directives, such as a health care proxy that lets you designate someone else to make medical decisions on your behalf if you can’t. They could cover a living will that specifies your preferences for medical treatment at the end of your life.
  • Provide a simple vision test.
  • Recommend tests, screenings and other preventive services that you may need to stay healthy.
  • Review any current opioid prescriptions and screen for potential substance use disorders.

The annual wellness visit provides a snapshot of your current health as a baseline for future yearly visits and is intended as a preventive service — a way of catching potentially serious health issues early.

This visit includes some of the same elements as the Welcome to Medicare checkup. For example, your doctor will review your medical history, record your vital information and give you an opportunity to talk about advance directives. Your doctor may also do the following during this annual visit:

  • Create a screening checklist for recommended preventive services for the upcoming year. 
  • Look at health risks and treatment options.
  • Perform a cognitive assessment to look for signs of dementia.
  • Provide personalized health advice.
  • Review your current providers and prescriptions.
  • Study risk factors for opioid problems if you have a prescription for opioids, and screen for potential substance use disorders.

How much do I pay for a Medicare wellness visit?  

The Welcome to Medicare and annual wellness visits are covered in full by Medicare Part B without any out-of-pocket costs if you use a doctor or other qualified health care provider who accepts assignment. You don’t need the Welcome to Medicare visit to qualify for later annual wellness visits, but know that Medicare won’t pay for a wellness visit during the first 12 months you have Part B.  

During these visits, the provider may order additional tests or procedures that may be subject to Medicare’s deductibles, copayments or coinsurance.  

Keep in mind

Be specific. Make sure to ask for the Welcome to Medicare checkup or annual wellness visit for Medicare to cover it. Otherwise, you may have to pay for the visit.

Medicare Advantage is different. If you have a Medicare Advantage plan rather than original Medicare, you may need to use an in-network provider for the wellness visits to be covered. Some Medicare Advantage plans cover annual physicals in addition to the wellness visit.  

Updated February 24, 2023

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